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Pills (Photo credit: erix!)

A few days ago New York City commenced public hearings on Mayor Bloomberg's proposal to limit the sale of sugary soft drinks to 16 ounces or less, part of a well-intentioned effort to combat obesity and the constellation of health problems that fat contributes to, or causes outright. Whether smaller drinks will make a difference is under debate, but the mayor's move is nevertheless instructive for many in the business of health – in particular, the pharmaceutical industry.

Pharma today is suffering from a life-threatening combination of afflictions. Patent cliffs are looming, development costs are rising, and margins are shrinking. In order for pharma companies to not only survive but once again thrive, they’re going to have to move beyond the cure-the-disease approach they've followed for centuries and embrace a business model that sees health as a far more complicated process of lifestyle and long-term behavior.

From infectious diseases to complex lifetime conditions.

It won't be easy for the pharmaceutical industry to break its addiction to pills. The last 100 years have yielded astounding scientific discoveries and successes: Alexander Fleming discovered penicillin in 1928; the 1940s yielded several iterations of the influenza vaccine; and Jonas Salk tested his first polio vaccine in 1952. In fact, in cases such as smallpox or polio, government-mandated vaccinations eradicated the diseases in the US and elsewhere.

But the battles against problems like obesity and heart disease look quite different from other historical health epidemics. That’s because our health landscape has drastically shifted from infectious diseases to complex lifetime conditions.

But here’s one key conundrum: While our health landscape has evolved, our healthcare landscape has yet to follow suit. There may or may not be a heart disease bacteria or a diabetes virus, yet we continue the race to develop blockbuster medicines that will wipe these scourges off the map. But without a single pathogenic culprit to target, pharmaceutical companies must expand beyond the formula of infectious diseases.

Relatively speaking, infectious diseases are a simple enemy. We target a pathogen along its very specific pathway. By breaking the disease chain, we can stop the undesirable outcomes. With infections, medicines have been incredibly effective, because symptoms are predictable and consistent across demographics. But in the world of complex or lifestyle diseases that have moved to the top of our healthcare priorities, we must consider issues such as our genetic profile, upbringing, environment, fitness, stress levels, sleep and diet – including, yes, even our daily soda consumption.

Discovering a silver bullet solution is becoming increasingly resource-intensive and risky for pharma companies. These disease chains have multiple catalysts that interact in ways that can be hard to quantify and understand.

Business as usual won’t keep pharma companies afloat. Shifting to a complex disease approach will be crucial to staying relevant in the new health landscape. While patient care and insurance have certainly been key areas for innovation in complex care, they’re not the only ones, and pharma better find them.

Three imperatives will enable pharmaceutical companies to make the transition to treating complex diseases: